Can You Still Have Rheumatoid Arthritis With Negative Blood Test
There are two main types of rheumatoid arthritis (RA) in adults: seropositive and seronegative. Both have the same symptoms — joint pain, morn stiffness, fatigue, fever, depression appetite — just the chief difference is in the bloodwork.
In almost people diagnosed with RA, claret tests reveal abnormally high levels of antibodies chosen rheumatoid gene (RF) and anti-cyclic citrullinated peptide (anti-CCP), which signal that the allowed system is in overdrive and may exist attacking healthy tissues instead of just foreign invaders like germs.
The majority of rheumatoid arthritis patients are seropositive: l percent to lxx percent of RA patients have anti-CCP antibodies and 65 percent to fourscore pct accept rheumatoid factor antibodies, research shows.
However, this means that a sizeable number of people with RA are considered to be seronegative, which means they don't have either of these antibodies in their claret.
Proceed in mind that blood tests are just one part of the process that doctors use to diagnose RA. Learn more almost different tests that diagnose RA here.
How Are Blood Tests Used to Aid Diagnose RA?
RF and anti-CCP tests don't definitively indicate to RA because some good for you people without RA test positive for these antibodies, while other people who do have autoimmune bug test negative, says Umbreen Hasan, MD, consultant rheumatologist for Allina Wellness in Minnesota.
That's why doctors will also consider RA symptoms, inflammation levels, and the amount of articulation swelling with the help of 10-rays and ultrasounds.
"Although blood tests for inflammatory arthritis can aid in the diagnosis of the condition, a skillful history and physical examination is more important," says Dr. Hasan. "The diagnosis [of RA] should not be solely based on blood tests."
Nevertheless, if you have symptoms that are consistent with rheumatoid arthritis and you do exam positive for these antibodies, your doctor will feel pretty confident existence able to diagnose you with RA.
How Do Doctors Diagnose Seronegative RA?
People who don't test positive for the presence of RF and anti-CCP tin can even so be diagnosed with rheumatoid arthritis based on their symptoms, a physical exam of their joints, and imaging tests (X-rays and ultrasounds) that tin can testify patterns of cartilage and bone deterioration.
Interestingly, some people who initially test seronegative develop those RF and anti-CCP antibodies later. Amid people with more than established RA, the percentage of seropositive patients rises to fourscore to 85 percent, says Konstantinos Loupasakis, Doc, rheumatologist with MedStar Washington Hospital Center.
Simply almost people with seronegative RA never develop antibodies and become seropositive.
Because doctors experience less confident diagnosing RA without positive blood tests, they'll need to rule out other conditions like viral infections, gout, or spondyloarthritis (an umbrella term for conditions such as psoriatic arthritis and reactive arthritis that isn't associated with high levels of RF and anti-CCP), says Dr. Loupasakis.
"We desire to be very conscientious that we are not missing something," says Dr. Loupasakis. "In that location are diseases that tin camouflage equally rheumatoid arthritis, and [your symptoms] might be something else."
This may help explain why inquiry shows that people with seronegative RA often accept longer to become diagnosed and to get-go treatment than people with seropositive RA, according to written report presented at the 2022 annual meeting of the American College of Rheumatology.
Is Seronegative RA Just Another Kind of Arthritis?
Only a seronegative test doesn't automatically point to spondyloarthritis, which is a separate condition, he says. The two types of inflammatory arthritis affect the joints differently, confirms Dr. Hasan. While rheumatoid arthritis generally hits small joints like the hands and feet, spondyloarthritis is more likely to start in the lower dorsum or shoulders.
Getting the wrong diagnosis can continue patients from the best treatment. While spondyloarthritis has its own canonical prepare of treatments, seropositive and seronegative RA are treated the aforementioned way. Both utilise illness-modifying anti-rheumatic drugs (DMARDs), biologics, corticosteroids, and anti-inflammatory NSAID painkillers similar aspirin.
The chief difference is that rituximab, an infused medication, is only effective for seropositive patients, though it's not among the first treatments a medico will prescribe anyhow, says Dr. Loupasakis.
Seronegative vs. Seropositive RA: Are There Other Differences?
Past studies seemed to indicate that seropositive RA patients had a worse prognosis and more severe disease progression than seronegative RA patients, according to MedPage Today. This has created a certain stigma around seronegative RA — that it is a "less astringent disease" and perhaps even requires less aggressive treatment.
Even so, the thinking here is irresolute based on newer research. For example, a Dutch study found that seronegative RA patients had significantly greater disease activity and worse functional ability than seropositive patients; on the other hand, seropositive patients had greater articulation damage.
A Canadian study found that measures of RA illness activity (such every bit number of swollen/tender joints or X-ray evidence of joint damage) was higher in seronegative patients than in seropositive patients when the study began. Both seronegative and seropositive patients received similar treatment. When measured again after two years, the seronegative RA patients had a significantly greater improvement in several measures of disease activity and less erosion than those with seropositive disease.
Part of the problem may be the delay in diagnosis. Because people with seronegative RA take longer to get diagnosed and offset affliction-modifying medication, they may be missing a crucial window to forbid progression and enter remission.
Agreement the differences betwixt seropositive and seronegative patients, as well every bit nuances within each of those groups, is an ongoing area of study. Both seronegative and seropositive RA likely have dissimilar subtypes that oasis't notwithstanding been teased out. Personalizing treatment and being able to better predict which patients will do better on which kinds of treatment is a hot topic in the field of rheumatology.
Lesser line, co-ordinate to MedPage: "RA patients classified as seronegative may indeed experience a level of affliction activity that is as astringent, or more severe, than patients who are seropositive, and thus may benefit from the type of aggressive treatment strategies that are more than routinely used to treat seropositive patients."
When People Say Seronegative RA 'Isn't Real'
Kate Mitchell of Boston knows all besides well the importance of getting the right diagnosis. Her rheumatologist first idea she had psoriatic arthritis because of a family history of psoriasis. Realizing she'd only ever had ii psoriasis flare-ups, her doctor suggested she might take seronegative rheumatoid arthritis instead. Those medications didn't work too every bit they'd hoped, so he put her back on medication to treat psoriatic arthritis, but her symptoms got fifty-fifty worse, and she developed endometriosis. She finally establish relief when she went dorsum to RA medications.
"I'm non spending my entire life in bed or on the couch," she says. "I can leave my firm for things other than a rheumatology appointment."
Mitchell had a good feel with her rheumatologist simply says she's run into other doctors who accept tried convincing her seronegative RA isn't real or that she has a different type of arthritis. She tries to remind herself that she knows her own body, but "other times it's upsetting and demoralizing," she says. Mitchell encourages patients to keep up with doctors' appointments to find a diagnosis — whether information technology's seronegative RA or something else.
"In that location are so many illnesses and forms of arthritis that do not have a definite examination to diagnose them," she says. "Just considering ane doctor or one rheumatologist says y'all do not take x form of arthritis doesn't hateful you don't have whatsoever of the other 100 forms."
Proceed Reading
- 15 Myths Nearly Rheumatoid Arthritis You Need to End Believing, Stat
- 14 Things to Never Say to Someone with RA (and 3 You Totally Should)
- The 4 Stages of Rheumatoid Arthritis Disease Progression
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